Stopping the Noise in Your Head is a Step-One intervention in what we call Stepped Care: a system to help those with health problems receive the best, most cost-effective help for their specific problem. Here, of course, we are addressing the mental health problems of anxiety, worries, panic, phobias, and OCD. Stepped Care is designed to use only the minimal resources necessary to get the job done. This book is within Step-One not because it’s so simple (although it is) or because it provides only the basic information. It belongs in this category because it is inexpensive, it’s readily accessible, and it’s one of the least intrusive interventions you can find.
In the self-help field, our questions will always be: How many people can be lifted up, and to what degree, by following the instructions within a Step-One resource like a book? Who can finish their work with this guidance? Who will be more prepared for professional treatment if they begin their work within the Step-One level? I believe lots of people who struggle with anxiety, noisy worries, and fearful avoidance can get stronger by applying the principles of this book. If you’re one of those people, then I think you can, too. What we don’t know is how strong you can get. Why don’t you find out? If this approach makes sense to you, continue studying these principles and tactics and then give it your all as you go into action. Even if you think it won’t help you, the only way you can know for sure is to put 100 percent of your effort toward engaging in our strategy. If you get lost, struggle to apply the principles without getting better, or simply don’t finish your work, then you can get further help.
If you don’t like the approach I’ve presented here, or it doesn’t help you get strong enough, then you still have options within this inexpensive Step-One level. At least a dozen high-quality self-help books and workbooks have been published in this field of anxiety by some of the top experts in the world, and more will be released each year. Pick another one and study it. Keep looking until you find a program you resonate with. Or check out the Internet for free (yet trustworthy) self-help guides. Look for software programs and apps that support your efforts. Then, whatever you pick, work that program. Because getting stronger isn’t about reading, listening, or watching, it’s about taking actions out into the world that move you toward your important goals.
Stepping Up to Professional Help
If you get stuck or if you haven’t gotten as far as you want to, then you can “step up” to a higher level intervention. In case you haven’t already done so, start by making an appointment with your primary care physician to check out whether any physical problem or side effect of medication is contributing to your symptoms, because they certainly can.
Warning: In an effort to provide you with the relief you want, your physician may prescribe a medication. While medications can certainly be part of a treatment regimen, they are not the only treatment available, and sometimes they are not even the best intervention. They are easy. You just take a pill each day. And we all like easy. But if you’ve read this book, then you know that “easy” isn’t always the best plan. In the territory of anxiety, you gotta be willing to do “hard.” Medications, though, can serve as a crutch to help some people do the hard stuff. There’s nothing wrong with using a crutch, as long as it is contributing to you taking a bigger step toward what threatens you. But if you only rely on a crutch and otherwise become passive when you really need to be active, then you are not moving in the right direction. So if you decide to take medication, make sure it is part of your action plan to get stronger, but not the only part.
If you do the best you can to work our strategy yet still don’t get as strong as you’d like, then an excellent next step is to work with a mental health professional who can help you finish what you’ve started. The good news is that absorbing the principles within this book will prepare you for treatment. If you are able to grasp these concepts, you will be a giant step ahead. Any mental health professional who specializes in anxiety treatment will be pleased to know that you have a basic sense about how to get stronger and have now come to request their help. It means that their time with you will be more efficient, even if you feel stuck. Being stuck is a solvable problem. The more you can enter that treatment session with a sense of how you are stuck, the more you will be ready to collaborate with your therapist in the task of getting unstuck. If you are clear about the task before you, your therapist can serve more of a coaching role, providing firm, dynamic support for your action and offering her expertise when you need it.
If you feel totally confused about what’s going on with you, that’s fine, too. You don’t have to have any understanding about how to get better. You can just say, “I have this problem, I’ve tried to work on it on my own, I’m stuck, and I need your help.” Then you follow that by saying, “This is what I want in my life: [fill in the blank]. And this problem is in my way.” It’s the therapist’s job to guide the conversation at that point, to ask you questions that further his understanding, and then to give you feedback about his perceptions regarding the ways you might be stuck and what you might need to do next.
If at all possible, I recommend that you work with a therapist who is a specialist in anxiety treatment. Specialists can be much more efficient in their work with you because they are more experienced with targeting anxiety disorders. This ought to mean that you will spend less time in treatment than you might when working with someone who works with lots of different problems. Specialists may describe their treatment approach using several different labels. Those who will be more closely aligned with the principles of this book will use terms like cognitive-behavioral therapy (or CBT), exposure treatment, exposure and response prevention, cognitive therapy, or acceptance and commitment therapy.
Even if no anxiety specialist works close enough to where you live, you may still find someone who can help. In your first treatment session, listen for a few qualities.
Ideally, her end of the conversation will sound along the lines of “I know what you mean. And this is how I think you can get stronger.” Just make this request of her at the beginning of the first session (so she saves enough time for it): “Before we’re done today, can you tell me your opinion about what I’ve said, and can you tell me how you might help me?” She should be able to give you that feedback in the initial session. But sometimes, especially if you have a complex story, it can take her longer. One response to be listening for is that every helpful therapist should know that you’re going to solve anxiety problems only by your actions. So if she doesn’t talk about how she will help you take action, I’m not sure she is the right fit for you.
Another quality that is just as important as all the others is that you need to feel a connection with this therapist. Do you sense that he can be your ally, and that your goals for treatment match? You need to have a good feeling about your relationship with him, his ability to establish rapport with you, his understanding of the problem and its potential solutions, and his ability to collaborate with you. If you don’t have that feeling of alliance, or if his goals seem to diverge from yours, then thank him and move on. Yes, it cost you the price of a first session. But step away if he doesn’t feel like a good fit. It’s similar to what any of us would do in a social gathering. We chat with people for a little bit, and if we don’t hit it off, we thank them, move on over to get some chips and salsa, and then look for someone else interesting.
By the way, you can’t expect that the therapist will know anything about this book or my strategy. Or if she does, she may not agree with everything I have said here. Some of my ideas might sound pretty crazy to her. “Talk to Anxiety? Be cunning? Oh, my heavens. I suggest you throw that book into the shower.” She still may be a great fit for you.
What Will You Take into Treatment?
You have a responsibility to take an attitude of determination into your sessions. I recommend an “I want this” attitude. Only go into treatment if you want to do the work of treatment. You don’t have to want to do it with all your heart, mind, and soul. A part of you, like a part of all of us, isn’t interested in doing the work, and that’s fine. Just don’t put that part of you in charge of your decisions. Treatment might be difficult, scary, take time, and cost you money. You have to decide it’s worth the investment and worth the risk. And then choose “I want this.” Want to be in treatment, either because you’re stuck, or you want to get stronger and need some coaching, or Anxiety is kicking your buttocks and you want to take back your life. Your therapist can’t give you attitude. You have to bring attitude. And I think it will make all the difference in the world.
Sources for Locating a Therapist
Five national and international organizations can help you find a therapist near you who specializes in anxiety treatment. I’ve provided the hyperlink to their home pages. Once you get there, click on any link that resembles the phrase Find a Therapist. Please note that professionals who appear on these lists are not certified in any specialty by these organizations (unless specifically indicated within their individual description). Joining these organizations does not reflect that the professional has any competence in treatment, much less treatment of anxiety. It only indicates their interest in that specialty. Nonetheless, these organizations are great places to start your search for a competent therapist who will help you get stronger.